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General NPI Number Information
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NPI Number | 1295202984
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Entity Type | Organization
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Legal Business Name | SUMMIT INTEGRATIVE HEALTH, LLC
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Dates
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Enumeration Date | 10/31/2018
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 12627 SAN JOSE BLVD STE 305
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8639
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Country | US
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Telephone | 904-683-4376
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Fax | 904-683-4378
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Provider Business Mailing Address
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Address Line | 12627 SAN JOSE BLVD STE 305
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8639
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Country | US
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Telephone | 904-683-4376
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Fax | 904-683-4378
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUSTIN TINKER
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Credential |
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Telephone | 404-405-9168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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